| NPI | 1962550327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 25125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW 12249) |
| 1041C0700X Social Worker, Clinical (Licence: CA ASW 12249) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2019-11-08 |